Premature ejaculation (PE) is a commonly reported sexual difficulty that men experience. It occurs in as many as 66 percent of the men who are diagnosed with sexual dysfunction problems. The etiology of PE may be psychogenic, physiologic or behaviorally conditioned. The methods that were previously used for treating this condition included behavioral therapy, psychotherapy and exercises such as the “squeeze technique” and/or the “start and stop technique.” These modalities, however, often required the participation of the partner.
In recent times, however, low doses of antidepressants referred to as selective serotonin reuptake inhibitors (SSRIs) approved by FDA for treating depression as well as some other health conditions have increasingly become the drugs of first choice for treating PE. Although used off label for treating PE, which supposedly is related, at least in part, to the presence of the brain chemical serotonin in lower levels, SSRIs act to promote the production of the neurotransmitter serotonin and increase the time it takes to reach ejaculation.
Are SSRIs Effective In Treating PE?
Most men with PE are seen to respond well to daily treatment using SSRIs. However, there are some significant side effects caused by the use of these drugs that patients may find to be very unpleasant. Researchers carried out a meta-analysis of the studies that examined SSRIs as well as clomipramine, an older type of antidepressant, that were used for treating PE. Analysis showed that use of clomipramine (Anafranil) and the SSRIs paroxetine (Paxil), sertraline (Zoloft) and fluoxetine (Prozac) were helpful in delaying ejaculation and help patients last longer in bed. Further, paroxetine had the strongest effect.
A narrower analysis focusing on 8 randomized, placebo-controlled trials wherein the time to ejaculation was measured using a stopwatch also proved the effectiveness of SSRIs in increasing the time to ejaculation. Studies that have analyzed the use of antidepressants on an on-demand basis for treating PE showed that it is not as effective as daily use treatment. In the case of on-demand use, men have to take the drug only prior to the sexual activity. Additionally, the drug is to be taken approximately 3 to 5 hours prior to the intercourse. This can greatly dampen the patient’s spontaneity. Though the on-demand PE treatment is a highly debated subject, most patients prefer to try this method as it greatly reduces the risk of side effects.
Are There Any Side Effects To Using SSRIs?
The use of antidepressants on a daily basis, even though they are used in lower doses to treat PE, can cause some side effects. Some of the commonly occurring side effects that are generally mild may gradually disappear in about a couple of weeks’ time. These include diarrhea, dry mouth, fatigue, nausea, drowsiness, perspiration and yawning. However, a few of the following more serious side effects can also occur in some of the patients who use SSRIs:
This is a black-box warning and the FDA’s most serious label alert. It states that using SSRIs reportedly increase the chances of development of suicidal thinking as well as behavior in children, teenagers, and young adults that are suffering from major depression or other psychiatric disorders. However, among patients who are 25 years or older with major depression, the chance of suicide is a lot lower.
This is a life-threatening reaction which happens often when two drugs that boost serotonin production are used at the same time. This causes coma, agitation, changes in blood pressure and heart rate, hallucinations, vomiting and loss of coordination. The usage of older antidepressants like monoamine oxidase inhibitors, medications for migraine headaches (triptan) such as tramadol (Ultram), almotriptan (Axert) and tryptophan supplements should be avoided. Some of the other drugs that are capable of raising serotonin levels in the brain include St. John’s wort, herbal products, OTC medications containing dextromethorphan (used for coughs) and prescription pain medications such as meperidine (Demerol, generic).
Different types of sexual dysfunctions caused by SSRIs include anorgasmia, erectile dysfunction, genital numbness, diminished libido and sexual anhedonia or pleasureless orgasm. Occasionally, sexual dysfunction may persist even after discontinuance of SSRIs. Though the mechanism that causes SSRIs to induce sexual side effects has not been well understood, it is believed, in part, that stimulation of postsynaptic receptors (5-HT2 and 5-HT3) decreases the release of dopamine and norepinephrine from substantia nigra. Further, a number of small studies have also showed that SSRIs are capable of adversely affecting the patient’s semen quality.
Patients who have been put on extended SSRIs therapy should not stop the medication abruptly. They should taper off the medication over several weeks in order to minimize the severity of the symptoms that are related to discontinuation. The withdrawal symptoms may include nausea, dizziness, chills, headache, body aches, paresthesias, electric shock-like sensations and insomnia. Paroxetine often causes greater discontinuation-related symptoms when compared with other SSRIs.
However, all SSRIs tend to cause qualitatively similar withdrawal effects. Fluoxetine causes the least amount of discontinuation effects.
Patients who are on diuretics are likely to be at a greater risk of experiencing the low sodium problem. Symptoms of low sodium include headaches, concentration and memory impairment, confusion, unsteadiness, and weakness.
The side effect is more common as well as higher in people who are on blood thinners/nonsteroidal anti-inflammatory drugs (NSAIDs) such as warfarin, aspirin, ibuprofen (Advil), etc., as part of treatment for other medical conditions. As SSRIs are known to interact with anticoagulants, the risk of GI, postoperative and intracranial bleeding is increased. However, the absolute risk may not be very high. Further, SSRIs may cause platelet dysfunction though the risk is higher in patients who are on NSAIDs, anticoagulants and antiplatelet agents as well as those who have co-existing underlying diseases like liver cirrhosis or liver failure.
Patients who are put on a daily dose of SSRIs as part of PE treatment to help them last longer in the bed are seen to gain weight. This in turn increases the risk of diabetes.
This is a rare side effect, (though desirable!) but patients who experience this kind of reaction should discontinue the use of the drug and also visit their doctor.